1. Health 201: Five Things
That Planners and Design Professionals need to know about Health and the Built Environment
This presentation aims to engage elected officials and leaders among planning and design professionals.
It could be delivered by any planning team member because in-depth presentation materials on the same topic already exist and a reference list is available. It is also suitable for web-based viewing.
The goal is to convince the audience that local government should care about the health effects of the built environment. It also explains that solutions can be developed from collaboration between planning and design professionals and Health.
Intended presentation time is less than 30 minutes, including questions.
Definition: “Built environments are the urban and rural human-made surroundings that provide the settings for human activity.   Built environments encompass buildings and spaces (e.g. homes, schools, workplaces, neighbourhoods, parks/recreation areas, industrial/commercial areas and other settings) the products they contain, and the infrastructure (e.g. transportation, energy and agricultural systems) that link and support them.” BC Ministry of Healthy Living and Sport.
Definition: “The built environment encompasses all of the buildings, spaces and products created… by people. It includes our homes, schools and workplaces, parks, business areas and roads. It extends overhead in the form of electric transmission lines, underground in the form of waste disposal sites and subway trains and across the country in the form of highways.”
Health Canada (1997) Health and Environment

2. Guide for using this presentation
This presentation is part of PHSA’s Healthy Built Environment Initiative. Find references and other resources at
Speaker’s Notes can be found in the small brown box in top left of each slide.
Users may freely use and adapt this presentation. Please credit PHSA. You can also insert local data at Slide 14.

3. Key message: Good planning and design can help build healthy places
The planning sector and local government already play an important role in creating healthy built environments.
Chronic illness and injury are a risk to both public health and our universal health care system.
Promoting healthy lifestyles alone is not enough. Effects of the built environment must also be addressed.
Professionals working in health, planning and design share a responsibility to promote active living and to modify the built environment.
Good planning and design can help people avoid or change unhealthy physical environments.
Local government already plays a very important role in HBE work for example in providing safe drinking water, tobacco control and air-quality measures such as anti-idling by-laws. The next step is to pick off some of the “low-hanging fruit” for further improvements.
Planners and design professions share with the health professions the ethical duty to improve the health and wellbeing of ALL those who use their services.
It is important to note that HBE work is related to other initiatives including reducing green house gases, reducing air pollution, managing traffic congestion, increasing street safety and vibrancy, etc.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

4. Health and the Built Environment
Five Things about
Health and the Built Environment
The impact of chronic illness and injury is immense; much is preventable.
Why are some people healthy while others are not? It’s not just genetics and lifestyle.
Many sectors of society influence population health.
The Built Environment affects health.
Collaborative action works.
Healthy built environments should concern everyone, not just health care providers.
If we do not address the causes of chronic illness and injury, we will be faced with social problems that have been compared in impact with climate change.
This presentation provides a high-level overview of the key topics.
It introduces the important concepts so that participants can see the “big picture” and why they need to take action.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

5. 1. The impact of chronic illness and injury is immense
Preventable chronic illness and injury cost BC’s health care system billions of dollars every year
Money spent on hospital care affects what we can spend on things that keep people healthy, like parks, active transportation and disease prevention
This presentation will explain how planners and design professionals play an important role in preventing illness and injury
Chronic Diseases and Injuries in Canada
Chronic diseases such as diabetes, kidney disease, heart disease and respiratory conditions account for 89% of deaths in Canada. Chronic diseases are expected to cause the deaths of two million Canadians over the next decade. Cardiovascular disease (CVD) is the leading cause of death in Canada and accounts for a loss of 4.5 years of life. In 2003, injuries were the second leading cause of death before age 70 in Canada.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

6. Why should planners care about runaway health care costs?
Resources spent on health care take away from other public benefits:
Early childhood development
Affordable housing
Education at all levels
Regional economic development
Clean air and water
Support for research and innovation
Transportation and recreation infrastructure
“As long as we keep spending money on hospitals, we will not have resources for early child development and care of seniors and other vulnerable people.”
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

7. The BC Health Care system makes up 49% of government expenditure
This slide illustrates how much government expenditure in BC is already going to health care. Much of this is preventable.
Costs of chronic illness in British Columbia are a major factor in these steadily increasing costs. CVD, cancer and diabetes account for 10.3% of the health care budget—or about $1.28 billion. The total direct cost of injuries reaches $852 million annually. Other chronic illnesses include arthritis, asthma and lung disease, kidney disease and vascular disease. Many are related to inactivity and environmental factors.
There are also significant social costs of preventable injury and chronic illness such as personal care, insurance costs, loss of income and taxes.
The message for local politicians is that there is an opportunity for potential economic gain in avoiding these costs. Communities that develop an age-friendly built environment may also be more successful in attracting new residents and businesses.

8. Obesity increases the risk for many chronic diseases
Obesity is a special concern because of the health impacts as shown in this slide, but also because it is so much more visible than other effects of the built environment (such as social inclusion or respiratory disease).
Obesity and overweight have been dubbed a ‘global epidemic’ by the World Health Organization (WHO). Obesity is a condition in which weight gain has reached the point where it poses significant risks to health. Obesity may be considered as a disease in itself and as a risk factor for other diseases.
Recently US researchers noted that obesity now equals smoking as a threat to health. “Obesity is the new tobacco.” Although this is not the only consequence of unhealthy lifestyles, the effect of obesity on other diseases makes it one of the most serious concerns.
In adults, obesity is associated with an increased risk of diseases that are a major cause of morbidity and mortality, notably type 2 diabetes, coronary heart disease (CHD), hypertension, various cancers and osteoarthritis.
In children the persistence of obesity into adulthood is the most important concern; the risk of persistence increases with increasing age of the child and the severity of obesity, but obesity also causes significant morbidity in childhood.
In general Type 2 diabetes follows the onset of obesity by about twenty years. Thus we fear a “conveyor belt” for today’s overweight children and adolescents to future chronic illness.
It is important to point out to officials, that local government has a record of success in encouraging active transport with collaborative projects involving BCRPA as a good example.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

9. Many injuries could be prevented by good design
Pedestrian fatalities higher than driving
Seniors and kids are the most vulnerable
Road design – wide arterials in suburban areas most dangerous
Traffic calming – reducing vehicle speed reduces risk of pedestrian injury
Public transit – decreases the number of automobile miles traveled
But – activity may be a risky behaviour if the built environment is not supportive. E.g. uneven or slippery pavement surfaces.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

10. 2. Why are some people healthy while others are not?
People’s choices to adopt a healthy lifestyle are limited by their income, social status, education, occupation, neighbourhood environment, social environment, etc
These factors are called the social determinants of health
These factors are often inversely related to health
Good planning and design can help reduce the inequities in people’s choices
“In relation to the built environment, the poor live downwind, downstream, downhill (but uphill if the slopes are dangerous), on floodplains and other marginal lands, near landfills, industrial plants and hazardous sites, in damp, unsafe, unhealthy housing, in dangerous neighbourhoods, and they work in unsafe, unhealthy workplaces. So place matters when it comes to their health.” (Trevor Hancock)
This is the most important message in the presentation: Good planning and design can help people avoid or change unhealthy physical environments.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

11. Look at the places on this map that are shaded in darker colours (Downtown Eastside, North Vancouver Island, rural and remote locations). Is there any surprise that these people live shorter lives due to natural causes of ill health?
“Potential years of life lost” [PYLL] is the number of years of life "lost" when a person dies "prematurely“. This is An indicator of premature mortality (death before age 75), which gives greater weight to causes of death occurring at a younger age than to those at later ages. This measure is calculated by subtracting the actual age of death from 75, dividing the total potential years of life lost by the total population under age 75, and then presented as "years lost per thousand people". By emphasizing the loss of life at an early age, PYLL focuses attention on the need to deal with the major causes of such early deaths - cancer, accidents and cardiovascular disease - in order to improve health status. For example, the death of a 50-year old contributes "1 death" to premature mortality, but "25 years" to PYLL; whereas the death of a 70-year old also contributes "1 death" to premature mortality, but only "5 years" to PYLL. PYLL has been found to vary with characteristics such as sex, socio-economic status and place of residence.

12. 3. Many sectors of society influence population health
‘Population health’ is an approach that aims to improve the health of the entire population and to reduce health inequities among population groups… It looks at and acts upon the broad range of [influencing] factors: social, economic and environmental health determinants”
Source: Public Health Agency of Canada
Improving population health usually requires multidisciplinary approaches (educational, environmental, behavioral and legal) and involvement of communities to address root or underlying causes of disease.
Many early gains in improving the health of populations came not from advances in medical science but from engineering, such as the provision of clean water, disposal of wastes, refrigeration, safer roads.
Health inequities are systematic disparities in health (or in the major social determinants of health) between groups with different social advantage or disadvantage (e.g. wealth, power, prestige).
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

13. Individual action can reduce the impact of health hazards
Individual action can reduce the impact of health hazards. But socio-economic factors make the job harder.
As each socio-economic factor makes the health gradient steeper, the individual has to work harder to avoid health hazards
“In [BC], as in other jurisdictions in the developed world, health tends to be unevenly distributed
among social groups within the population on a gradient corresponding to socioeconomic status. The
data in this report show that, in general, people from more advantaged socioeconomic groups enjoy
longer life expectancy and better health than people from less advantaged groups.
Inequities are reflected by consistent differences in the prevalence of chronic diseases (e.g., heart disease, kidney disease and
diabetes) among people from the highest and lowest income and education groups across the province; the
lower a person is on the socioeconomic hierarchy, the greater their risk of developing these diseases.” (Health Officers’ Council of BC 2008)
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

14. What does population health look like in our community?
Placeholder for local data e.g. birth rate, proportion of seniors, health and illness indicators etc. (see the geography of wellness and well being across British Columbia)
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

15. 4. The Built Environment has an impact on health
Community design can impact:
Traffic safety and injury prevention
Neighbourhood walkability
Access to public transit
Mental health affects of noise
Air and water quality
Access to healthy foods
Social inclusion
Disability access
Access to affordable and safe housing
“The built environment is part of the overall ecosystem of our earth. It encompasses all of the buildings, spaces and products that are created, or at least significantly modified, by people. It includes our homes, schools and workplaces, parks, business areas and roads. It extends overhead in the form of electric transmission lines, underground in the form of waste disposal sites and subway trains and across the country in the form of highways.”
Health Canada (1997) Health and Environment
The BE has impacts on both the physical environment - Building design and location, Streets, Noise, Air and water quality, Traffic safety and injury prevention as well as social environment including social inclusion, disability access and housing and food security
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

16. Prompts clockwise from upper left
How would you interpret the relationship between population health and the built environment in these pictures?
Prompts clockwise from upper left
Idling car –asthma (anti-idling by-laws)
Urban sprawl - loss of farmland, inactivity, air pollution, traffic injuries
Unsafe sidewalk – discourage activity, falls, traffic injuries
Homelessness – poor health, social exclusion, loss of productivity, discourage activity by others
Subdivision design – reliance on cars, inactivity, asthma
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

17. How we design and create our built environments - at every level from the design of products to the design of city-regions - has significant implications for health and other aspects of human development.
Planning and investment policies also include plans and zoning and development rules, development pressures, provincial transportation initiatives, among others… City building is more complex than just zoning bylaws.
“Smart growth” doesn’t mean “no growth,” but it does mean planned growth.
The health impacts of land-use decisions need as much consideration as economic impacts.
Design communities around people rather than around automobiles
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

18. 5. Collaboration is necessary to create Healthy Built Environments
Complex problems require solutions from many sectors…
… and leadership by community groups, planners, the development industry, engineers, design professionals, health professionals and elected officials.
Tobacco control is a successful example of cross sector collaboration
Public health professionals and those in architecture, engineering, design and planning have much in common.
The challenge now is for each profession
to learn from the others
to determine what answers each has that the other needs,
to create a common language, and
to initiate the opportunities to use it.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

19. Tobacco Control – an example of successful cross-sectoral collaboration
Smoking rates have dropped dramatically in regions where comprehensive policies have been implemented. Health services alone cannot achieve this.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

20. Municipal and Regional Licensing
Tobacco Control – an example of successful cross-sectoral collaboration
Health
Media Policy
Municipal and Regional Licensing
Tax Policy
School Programs
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

21. The health sector and planners have many opportunities for collaboration
Environmental factors air and water quality, noise, heat
Housing quality, affordability
Access and inclusion mental health and disability, arts and culture
Injury prevention
Physical activity transportation, recreation, connectivity
Nutrition and food security
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

22. Summing Up
The planning sector and local government already play an important role in creating healthy built environments.
Chronic illness and injury are a risk to both public health and our universal health care system.
Promoting healthy lifestyles alone is not enough. Effects of the built environment must also be addressed.
Professionals working in health, planning and design share a responsibility to promote active living and to modify the built environment.
Good planning and design can help people avoid or change unhealthy physical environments.
The design professions share with the health professions the ethical duty to improve the health and wellbeing of ALL those who use their services.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

23. Image sources Page 1: www.wikipedia.com; www.eps-newswire.com
Page 2: Dan Burden (
Page 8:
Page 14: City of Peterborough; LEES + Associates
Page 17: LEES + Associates
Page 20: Co-operative Housing Federation of BC; Lower Trinity South Regional Development Association
Page 21: LEES + Associates
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT

24. Evaluation
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NOTE: Responses can be sent to the Provincial Health Services Authority (PHSA), Attention Jane McCarney, , fax Evaluations can be anonymous but your organization and department name would be helpful for our reference.
HEALTH 201: FIVE THINGS THAT PLANNERS AND DESIGN PROFESSIONALS NEED TO KNOW ABOUT HEALTH AND THE BUILT ENVIRONMENT